New hope for stroke patients

Brain stimulation, therapy may prove a strong duo

December 31, 2006|By Leslie Goldman, Special to the Tribune

Nine years ago, at age 25, Christopher Ware of Downstate Clinton suffered a stroke that paralyzed his right side. "The doctors said I would never talk, walk or use my right hand again," he remembered. They wanted to admit him to a nursing home.

Through sheer force of will--he had been healthy until then, active in the local police force and with the Coast Guard--Ware taught himself to walk again and made his way out of the hospital three weeks later. But he was left with considerable physical disability, aching for a more familiar way of life.

In 2004, he heard about an advance in the field of neurostimulation, a process called cortical stimulation, that could help when combined with intense physical therapy. Ware tried it, and now, at age 34, he can tie his shoes, knot a tie instead of using a clip-on, and drive. Simply put, he said, "I can do more things independently."Ware was part of a national clinical trial designed to see whether cortical stimulation can reverse paralysis either partly or completely.

For America's 5.5 million stroke sufferers, one of the most common and disabling results is paralysis of an arm, leg or both. This can be especially troublesome when it affects an upper limb, because such a disability affects a person's ability to dress, dial the phone, cook or perform other daily activities, said Dr. Robert Levy, a professor of neurological surgery and physiology at Northwestern University's Feinberg School of Medicine and one of the researchers in the trial.

Until now, treatment primarily has been limited to physical therapy, but cortical stimulation is offering new hope.

The technique involves providing low-level electric current to the precise area of the brain responsible for hand and arm movement (the current is not felt) while the patient undergoes aggressive physical therapy involving the hand. Combined with the treatment, there is more lasting improvement than with physical therapy alone. The process, it is thought, works by promoting the strengthening of certain connections within the brain to compensate for those that were damaged.

Treatment begins with a specialized MRI scan that is done while the stroke patient performs certain wrist movements. This way, doctors can pinpoint the exact location of brain damage. Then, Levy explained, that scan is used in the operating room to guide surgeons as they make a small incision in the skull, removing a silver dollar-sized piece of bone and placing a small electrode over the fibrous brain covering directly above the area responsible for paralysis. The electrode is connected via a wire under the skin behind the ear and down to a pacemaker-like device implanted in the patient's chest. The device is taken out after about eight weeks.

Sponsored by Northstar Neuroscience Inc., which developed the cortical-stimulation device, EVEREST is based on a number of research studies and two human studies, one of which also showed that cortical stimulation could help speech, language and spatial orientation problems in stroke sufferers. Levy is excited about the possibilities.

"In my 20 years of dealing with patients with neurologic disease, this is the first and only potentially effective treatment I've seen for paralysis after stroke," he said. "It's remarkable, and I think its potential can be life-altering.

"We're only looking at the tip of the iceberg. . . . The fact that people are getting better suggests that once we get more experienced at it, it may be even better than we think."

Researchers are looking for more people to take part in the trial, which provides six weeks of free rehabilitation. Anyone interested should call 866-394-7303 or 866-394-7302 to find out if they qualify at Northwestern or the University of Illinois at Chicago, respectively. Information also is available at northstarneuro.com.